Provider Demographics
NPI:1376022343
Name:DIMAURO, ALICIA (DPT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:DIMAURO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3317
Mailing Address - Country:US
Mailing Address - Phone:734-546-5540
Mailing Address - Fax:
Practice Address - Street 1:500 W CUMMINGS PARK STE 2100
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6513
Practice Address - Country:US
Practice Address - Phone:781-305-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist